The invention relates generally to monitoring equipment for illustrating data about a patient to which the equipment is connected, and more particularly to prioritization systems and methods for accurately determining actionable alarms for a patient monitored by the equipment.
In medical monitoring devices that are currently utilized, for the continuous monitoring of patients connected to these devices, data is obtained by the device from various sensors connected to the device. This data is displayed on the monitoring device as numerical values for the various parameters being monitored that are represented on a screen of the device. The clinicians observing the screen and the numerical values represented thereon derive the necessary information by viewing and analyzing the numerical values.
In collecting and formatting the data from the patient for display on the associated screen, the monitoring device can also generate alarms based on sensed events determined by the stored criteria and parameter limits regarding the data collected by the monitoring device and represented by the numerical values. In most situations, the alarms corresponding to the sensed events represented in the data in the displayed are various types of audio and/or visual indicators generated from the monitoring device.
While these devices provide displays and methods of operating the displays that are capable of organizing information relating to various alarm events or conditions for review by an individual, there are a large number of parameters presented on the screen at any given time which are often associated with large numbers of alarms, especially for patients under care in the typical Intensive Care Unit. Due to the large number of the alarm events which may be occurring at a given time across multiple patients being monitored in the care area, certain highly important clinical events could inadvertently be overlooked or missed. This is often referred to as alarm fatigue and results from the constant representation of the alarm events in a similar manner that can cause certain events to become “lost” in the flood of alarms and associated information represented on the display screen of the particular device.
In addition, many of these alarm events are either false positive alarms or are in fact not actionable alarms for the general care area or a specific patient. If this alarm information is not managed by the site, it can further contribute to general alarm fatigue of the patients and staff.
As a result, for situations where the alarm events are in fact true positives, alarm fatigue can contribute to a situation where clinicians failed to identify those patients under care that have adversely trending alarm events. If the patient condition continues to worsen there can be long term injury. Early identification of the specific patients that are deteriorating allows clinical care givers to change their treatment to avoid long term injury.
To address this problem, a number of methodologies for assessing and reporting alarms currently exist and include the following:                1) Clinical Workflows/Personal Vigilance—This system and method relies on clinical workflows for the site, staffing assignments and personal vigilance to properly manage the configuration and patient specific actions that need to be done. This system and method has the limitation that it does not eliminate human error of the clinicians.        2) Early Warning Score (EWS)—This method and system is typically part of a Clinical Decision Support system where a score is created based upon the correlation between observations of a plurality of parameter values for a particular patient. Some systems of this type even allow the end user the ability to configure hard limits or even rates of change to contribute to the score. While these methods and systems can be valuable for identifying the current acuity of the patient, they also have the limitation that the information is essentially provided in the manner of additional notifications in the clinical care area which need to be separately identified and managed by the clinical staff. Additionally, these systems and methods do not address the specific configurations (e.g. alarm limits and level) of the primary method of monitoring patient care which is the patient monitor.        3) Simple data range count—This system and method involves simply counting the number of events occurring over a specified time period (e.g., 4 hours). While limiting the analysis time range is advantageous, there is no ability in these systems and methods to distinguish situations where all the events occurred at the beginning of the specified time period as opposed to all of the events occurring near the end of the specified time period. In former situation the acuity is in fact decreasing, and the later situation the acuity of the patient is increasing, which cannot be determined in this system and method.        
In addition, with regard to prior art systems and methods, the alarm events are treated equally in these systems, which does not provide an accurate measure of the significance of any individual alarm events. In particular, depending on the specific workflows of the clinical care area, some alarm events may not be important to the clinical care of the patients, while others are vital. The above existing technologies simply lump the alarm event that occur into very broad categories of assessments without the ability to identify which alarm events are more critical to a particular patient, and thus require additional attention as a result.
In more recent attempts to address the shortcomings of these currently existing systems and methods, a number of alternative alarm metric systems have been developed.
In particular, US Published Patent Application No. US2008/0214904 discloses an apparatus to measure the instantaneous acuity value for a patient. The apparatus and method disclosed utilizes values for monitored physiological parameters and other criteria about the particular patient to create a composite acuity score for the monitored patient based on the underlying preset scoring parameters for the overall system. As the parameters change, the score for the patient can change when the parameters fall out of predetermined ranges for the particular scores associated with that parameter to provide a variable acuity score indicative of the current severity of the condition of the patient, and to trigger any required alarm condition for the patient.
However, while the system of the '904 application provides an enhancement over other prior art systems and methods, that system utilizes preset values and parameter ranges for determining the acuity score for a particular patient. As a result, the system cannot be configured to reflect the needs of a particular care area, and the patients being monitored and treated in that area. Further, the system focuses on the physiological parameters of the patient, and does not account for any potential issues regarding alarm fatigue in the clinical area in which the system is operated.
Further, WO2014/087288 discloses a system and method to reduce nuisance alarm load. The system operates by reviewing the number and types of alarms generated by the patient monitors, and response times for the clinicians to those alarms. Based on the review, the system can determine which patients have exceeded an alarm threshold, either in number of alarms generated or response time for alarms generated, and can send notifications other than alarms to the treating clinicians regarding those patients.
Additionally, US Patent Application Publication No. 2013/0162424, which is expressly incorporated by reference herein in its entirety, discloses a system and method for monitoring clinician responsiveness to alarms. In this system, the response time for clinicians to respond to alarm events generated by patient monitors is determined and used to produce a responsiveness score. The responsiveness score can then be used to further issue enhanced alarms, such as escalated alarms, alarm fatigue notifications.
However, in each of these systems and methods, the system operates only a basis of very simple scoring metric, which is not customizable to the particular care areas in which the system is being utilized. Further, the alarm fatigue determinations in these systems are focused on individual clinicians and their responsiveness to the alarms, rather than with regard to the alarms themselves at a clinical care area level.
Therefore, it is desirable to provide an improved system and method of evaluating patient alarm conditions that incorporates a tailored configuration for patients a care area in which the system is utilized in conjunction with an evaluation of alarm events occurring in the care area to effectively reduce the level of alarm fatigue and increase the effectiveness of patient care in the care area.